Get started now…on the look and life you’ve wanted!

1. Client Information		Female	Date:
Name		Day Phone
Address		Eve Phone
City		State	Zip
Country		Postal
Email		Birth Date (mm-dd-yy)
2. Color Photograph
Photo
3. Human Visual Design ™ Evaluation
Check which best describes your natural coloring and bone structure.
Natural Hair Color (at age 10-12) BlondLight BrownMedium BrownDark Brown/BlackRed
Natural Eye Color Light/Medium BrownDark Brown/BlackGreen or HazelBlueGray
Surgery: Have you had cosmetic surgery that changed your *facial bone structure? (*not facelifts or peels) NoYes  If yes, was it: nosechincheekseyes
4. Energy Characteristics  Circle the words that describe your energy:
High-Energy Outgoing Talkative Cheerful Friendly Total row 1 Reserved Inward Quiet Subdued Analytical Total row 2 Direct Strong Opinionated Practical Bold Total row 3 Calm Self-Contained Composed Firm Controlled Total row 4
5. Personal Style Expression Circle the words that you feel describe your look or your personality. The Profile is based on your photo and responses.
Refined Elegant Quality Tasteful Finished Smooth             Natural Casual Relaxed Informal Athletic Earthy             Timeless Classic Tailored Conservative Quality Tasteful             Current Stylish Fashionable Sophisticated Trendy Up-to-Date             Romantic Feminine Pretty Charming Soft Appealing             Sexy Alluring Playful Suggestive Engaging Captivating             High Impact Dramatic Enticing Bold Powerful Strong             Creative Original Unique Interesting Intriguing Imaginative
6. Payment:   $____ ($_____+ $4.50 tax + $5 s/h) Total $_______
Method of Payment: CheckCashCredit Card
Check #     Credit Card Type VisaMasterCardDiscoverAMEX     Credit Card Number Exp Date Name on Card (if different from above)